九项新降糖药物心血管结局大型临床试验的网状荟萃分析。

Network meta-analysis of nine large cardiovascular outcome trials of new antidiabetic drugs.

机构信息

Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Qassim University, Qassim, Saudi Arabia.

King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.

出版信息

Prim Care Diabetes. 2019 Jun;13(3):204-211. doi: 10.1016/j.pcd.2019.01.003. Epub 2019 Jan 31.

Abstract

The aim of this network meta-analysis (NMA) was to indirectly compare the cardiovascular (CV) safety of new antidiabetic medications in patients with type 2 diabetes mellitus (T2DM). DATA SYNTHESIS: A search of the Embase and MEDLINE databases was conducted systematically to identify cardiovascular outcome trials (CVOTs) of new antidiabetic medications (DPP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors) in patients with T2DM. The primary outcomes were the composite endpoint of CV death, nonfatal MI, and nonfatal stroke (MACE), death from CV causes, nonfatal MI, nonfatal stroke and death from any cause. Hospitalization for HF and unstable angina were evaluated as secondary endpoints. A total of 9 trials, including 87,162 patients, met the eligibility criteria and were retained for the analysis. The NMA results showed no significant differences among the DPP-4 inhibitors (sitagliptin, alogliptin, and saxagliptin) in any of the CV endpoints. Similarly, no significant changes were seen in the NMA among the GLP-1 receptor agonists nor the SGLT-2 inhibitors. The pairwise meta-analysis showed that DPP-4 inhibitors have a CV safety profiled comparable to placebo. GLP-1 agonists on the other hand, showed significant reduction in MACE (RR 0.92; 95% CI 0.87-0.97), death from CV causes (RR=0.88; 95% CI 0.80-0.97), and death from any cause (RR=0.89; 95% CI 0.82-0.96). SGLT-2 inhibitors showed significant reduction in hospitalization for heart failure events (RR 0.72; 95% CI 0.6-0.86) compared to placebo. CONCLUSION: This meta-analysis has shown that new antidiabetic medications do not impose any additional CV risk. The indirect comparison among the medications of each class resulted in no significant changes regarding CV endpoints and death from any cause.

摘要

本网络荟萃分析(NMA)旨在间接比较 2 型糖尿病患者新的抗糖尿病药物的心血管(CV)安全性。

数据综合

系统检索 Embase 和 MEDLINE 数据库,以确定 2 型糖尿病患者新的抗糖尿病药物(DPP-4 抑制剂、GLP-1 激动剂和 SGLT-2 抑制剂)的心血管结局试验(CVOT)。主要结局是 CV 死亡、非致死性心肌梗死和非致死性卒中(MACE)、CV 原因导致的死亡、非致死性心肌梗死、非致死性卒中以及任何原因导致的死亡的复合终点。HF 和不稳定型心绞痛住院被评估为次要结局。共有 9 项试验,包括 87162 名患者,符合纳入标准并纳入分析。NMA 结果显示,DPP-4 抑制剂(西他列汀、阿格列汀和沙格列汀)在任何 CV 终点均无显著差异。同样,GLP-1 受体激动剂和 SGLT-2 抑制剂之间的 NMA 也未发生显著变化。成对荟萃分析显示,DPP-4 抑制剂的 CV 安全性与安慰剂相当。另一方面,GLP-1 激动剂显著降低 MACE(RR 0.92;95%CI 0.87-0.97)、CV 原因导致的死亡(RR=0.88;95%CI 0.80-0.97)和任何原因导致的死亡(RR=0.89;95%CI 0.82-0.96)。与安慰剂相比,SGLT-2 抑制剂显著降低心力衰竭事件住院率(RR 0.72;95%CI 0.6-0.86)。

结论

本荟萃分析表明,新的抗糖尿病药物不会增加任何额外的 CV 风险。对每类药物的间接比较在 CV 终点和任何原因导致的死亡方面没有显著变化。

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